Self-reported infections during international travel and notifiable infections among returning international travellers, Sweden, 2009-2013 - Fig 2

<p><b>a</b>. Incidence of self-reported gastro-intestinal and respiratory infections, per continent. International travellers. Sweden 2009–2013. <b>b</b>. Incidence of self-reported gastro-intestinal and respiratory infections per age group. International travellers. Sweden 2009–2013.</p

Number of notifiable infections, and incidence per million days of travel, for travel-associated notifiable diseases, per continent.

<p>Returning international travellers. Sweden 2009–2013.</p

Number of notifiable infections, and incidence per million days of travel, for the five countries with the most infections per disease group.

<p>Returning international travellers. Sweden 2009–2013.</p

Days of international travel per continent.

<p>Coloured bars represent the five countries with highest number of days of travel. International travellers. Sweden 2009–2013.</p

Number of self-reported gastro-intestinal and respiratory infections, and incidence per million days of travel, for the five countries with the most infections.

<p>International travellers. Sweden 2009–2013.</p

Prioritization variables.

<p>AMR = anitimicrobial resistance</p><p>Note 1. All criteria apply to the geographical settings where the prioritization is conducted; the time-frame applicable to the requested epidmiological data should be defined prior to the process initiation and depends on the frequency with which pathogens are planned to be re-scored. Indicated numercial thresholds apply to the country where the prioritization is conducted: In other geographical settings different thresholds might need to be considered.</p><p>Note 2. Event is defined as the occurrence of a disease that is unusual with respect to a particular time, place or circumstances. For certain infectious diseases one case may be sufficient to constitute an event (e.g. polio virus). Public health actions are any kind of targeted actions aiming to identify the nature of the event and/or to apply control measures in response to the event occurrence.</p><p>*assessed against the total burden of infectious diseases.</p><p>**assessed for each particular pathogen in question, e.g., the criterion "Treatment possibilities and needs" refers to availability and adequacy of treatment for each case of an illness caused by a particular pathogen but does not take into account the incidence of illnesses or the availability of preventive measures.</p><p>The ten variables that pathogens were scored for during the prioritization and the criteria for each score.</p

Communicable Diseases Prioritized According to Their Public Health Relevance, Sweden, 2013

<div><p>To establish strategic priorities for the Public Health Agency of Sweden we prioritized pathogens according to their public health relevance in Sweden in order to guide resource allocation. We then compared the outcome to ongoing surveillance. We used a modified prioritization method developed at the Robert Koch Institute in Germany. In a Delphi process experts scored pathogens according to ten variables. We ranked the pathogens according to the total score and divided them into four priority groups. We then compared the priority groups to self-reported time spent on surveillance by epidemiologists and ongoing programmes for surveillance through mandatory and/or voluntary notifications and for surveillance of typing results. 106 pathogens were scored. The result of the prioritization process was similar to the outcome of the prioritization in Germany. Common pathogens such as calicivirus and Influenza virus as well as blood-borne pathogens such as human immunodeficiency virus, hepatitis B and C virus, gastro-intestinal infections such as <i>Campylobacter</i> and <i>Salmonella</i> and vector-borne pathogens such as <i>Borrelia</i> were all in the highest priority group. 63% of time spent by epidemiologists on surveillance was spent on pathogens in the highest priority group and all pathogens in the highest priority group, except for <i>Borrelia</i> and varicella-zoster virus, were under surveillance through notifications. Ten pathogens in the highest priority group (<i>Borrelia</i>, calicivirus, <i>Campylobacter</i>, <i>Echinococcus multilocularis</i>, hepatitis C virus, HIV, respiratory syncytial virus, SARS- and MERS coronavirus, tick-borne encephalitis virus and varicella-zoster virus) did not have any surveillance of typing results. We will evaluate the possibilities of surveillance for the pathogens in the highest priority group where we currently do not have any ongoing surveillance and evaluate the need of surveillance for the pathogens from the low priority group where there is ongoing surveillance in order to focus our work on the pathogens with the highest relevance.</p></div

Prioritized pathogens.

<p>* In Germany included in Fungi (other)</p><p>**Helminths (flukes) group includes: Clonorchis sinensis, Opisthorchis felineus, Opisthorchis viverrini, Fasciolopsis buski, Fasciolopsis gigantica and Fasciolopsis hepatica, Paragonimius, Schistosoma</p><p>***Helminths (nematodes) group includes: Ancylostoma braziliense and caninum, Angiostrongylus, Ascaris lumbricoides, Capillaria philippinensis, hepatica and aerophila, Dracunluse meditensis, Enterobius vermicularis, Filaria (Onchocerca volvulus, Loa loa, Wuchereia bancrofti, Brugia malayi and Brugia timori). Hookworms (Ancylostoma duodenale and Necator americanus), Strongyloides stercoralis, Toxocara canis and cati, Trichuris trichiura. Trichinella spp. was scored as a separate pathogen</p><p>****Helminths (tapeworms) group includes: Diphyllobotrium latum, Echinococcus granulosus, Echinococcus multilocularis, Hymenolepsis nana, Taenia saginata, Taeniasolium</p><p>*****In Germany belonging to Hantavirus group</p><p>M = Mandatory notifiable, V = Voluntary notifiable, TP = Typing at the Public Health Agency of Sweden, TC = Surveillance of typing results done at county level</p><p>A list of pathogens in each priority group with information on type of ongoing surveillance (if any), Sweden, 2013. Group of priorizitation in Germany (8) is given in parenthesis.</p

Sociodemographic characteristics of Vårdguiden.se users compared with the Swedish population, 2012.

†<p>Totals do not always add up to 3000 due to missing answers</p><p>*p value for the chi square goodness of fit test</p><p>** out of the 16–74 year old 2012 Swedish population, n = 6893915.</p

Week number when activity crossed the epidemic threshold for norovirus laboratory notifications, and searches for “kräk” (vomiting) and “vinterkräksjuka” (winter vomiting disease) in Websök along with number of weeks gained for each search term compared with laboratory notifications, Sweden, 2006/2007 - -2012/2013.

<p>Week number when activity crossed the epidemic threshold for norovirus laboratory notifications, and searches for “kräk” (vomiting) and “vinterkräksjuka” (winter vomiting disease) in Websök along with number of weeks gained for each search term compared with laboratory notifications, Sweden, 2006/2007 - -2012/2013.</p